Toward a personalized screening from 40 years-old:
Breast cancer remains a serious disease, associated with long-term after-effect and its treatments are heavy, even at an early stage. Its prognosis is related to biology and tumor mass at diagnosis. Although treatment has led to significant advances, breast cancer screening remains a necessity. Screening mammography allows for earlier diagnosis and a lower risk of death from breast cancer. 2, 3, 4, 5, 6
Current screening for breast cancer in Western countries is focused on mammography, with modalities and target populations that vary from one country to another, but include women aged 50 to 69 at least (74 in France). ). The methods of screening as it is practiced today have limitations: limited benefit, imperfect sensitivity, over-diagnosis, irradiation and starting at age 50, whereas more than 20% of cancers occur before age 50.
It seems necessary to improve both the objective performance of screening and the performance felt by the population. One of the improvement solutions is the establishment of a personalized screening whose frequency and modalities depend on the risk of each patient. A risk factor increases the probability of developing breast cancer; it is evaluated statistically.
This individualized approach, has the advantage of being theoretically more acceptable to people than screening for all without distinction outside of age.
Screening and prevention adapted to the level of risk are standard measures in public health, validated in many areas such as metabolism, cardiovascular diseases, infectious diseases …
A highly efficient model of personalized risk-based screening and prevention is the management of women at high genetic risk of breast cancer, in relation to germinal mutations in the BRCA1 / 2, TP53, PALB2, etc. genes. It has been shown for the most frequent cases, in relation to BRCA1 and BRCA2, an improvement in overall life expectancy, by intensive specific screening and / or surgical prevention (levels of evidence II) 7.
With the results of extensive prospective studies currently underway (Wisdom in the United States, MyPeBS in Europe and a Prospective Study in Canada) the majority of the population should benefit from a personalized approach to breast cancer screening, allowing not only to scale up screening for higher-risk women, but also to space out screening for women at lower risk.
While waiting for these results, the MammoRisk® test already allows the doctor to propose a personalized screening plan to his patient, possibly with a higher frequency or an earlier age of start of the examinations, if she is identified at risk more high than the average of women at the same age.